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Monday, April 7, 2014

Treating the Person, Not the Disease

Last week we (Ali, Lauren and Caitlin Robertson) worked between the women and male wards. Our focus was to assess the most acute patients and care for the patients with the resources available to us. The most valuable learning experience for us was recognizing the lack of mental health resources for acute patients on the ward. We worked with three cases in particular where the psychosocial assessment of the individuals was lacking and not as prioritized in the care plan as we thought necessary.

One situation involved a patient who was transfered from the mental health unit onto the women’s ward. She was presenting with clinical symptoms of meningitis. Meningitis effects the brain and causes an altered state of mind, which can easily be mistaken as mental illness. Although this was her diagnosis and was being effectively treated, the staff members were passing these symptoms off as a mental health illness and low priority, rather than as an acute medical condition. There was an obvious stigma present on the ward.

This was also the case with two other patients we cared for throughout the week; one of which was very similar to the scenario mentioned above. Our most significant situation involved a patient who was brought in to the male ward by our fellow nursing student Sarah Duddle. Sarah was working in the outpatient department that day when he came in after ingesting rat poison. It was mentioned to us that rat poison is a common choice for suicide attempts.

The attention given to this patient was minimal and lacked a sense of urgency. Without the efforts of Sarah, he most likely would have passed away in the outpatient unit with no interventions. The young man’s condition was brought to our attention just early enough where we could intervene. We fought for medical attention from the charge nurse and the attending physician; it was very frustrating. We didn’t feel that this situation was being treated as an emergency. We pushed to have an NG tube inserted to suction the poison out of his stomach and to administer charcoal which induces vomiting. We were successful in both interventions as well as advocating for the attention and care that he deserved.

Throughout these situations we were shocked at how the patients were ignored and put to the wayside, and we didn’t understand why. It wasn’t until reflection, that we were able to better understand the actions of the staff. It wasn’t that they didn’t care about this patient, rather that they do not have the same resources available to them that we are used to in Canada. There are minimal interventions and diagnostics available, so much that we were unable to provide something as simple as oxygen. LGH is also understaffed, especially with psychiatric nurses (there are only two in the entire hospital!). Even in Canada, mental health care is lacking and could be improved on.

There is also a huge stigma around suicide and unfortunately for these patients the nurses and staff members have minimal training. It was hard to hear that the suicide cases are common here, and yet they are not addressed in a manner that we deem appropriate. Ensuring patient’s receive adequate mental health care is even a problem we are fighting as nurses back home in Canada. This experience has helped us recognize the importance of treating mental illness with the same patient care standards we would any other condition. We are trained to treat everyone with a holistic approach, without passing judgement. This proved to be successful in our practice last week.

We are so happy to know that our efforts assisted in saving the life of this young man. We were pleased to find out he was discharged today and following up with some counseling services.